Abstract:

Background: Labor is the physiological process by which regular painful uterine contractions result in progressive effacement, dilatation of the cervix and ultimately leads to delivery of the fetus through the birth canal. Interventions given to women admitted in latent or active phase of labor may influence the outcomes of labor and ameliorate complications which can affect the mother and fetus. Despite these, maternal and fetal outcomes among low risk women presenting in latent phase compared to active phase of labor at Bugando Medical Centre (BMC) have not been explored, and thus, a need to determine these parameters.

Methodology: This was a cross-sectional study conducted in labor ward at BMC Mwanza Tanzania from February to April 2013 involving 500 low risk women presenting in their latent phase (250 women) and active phase (250 women) of labor. Demographic and clinical data were collected using structured checklist and patient files.

Results: Of 500 pregnant women enrolled in this study, the mean age was 25.42±5.25 years (minimum 18 and maximum 40 years). Rates of interventions like oxytocin augmentation, artificial rupture of membrane and caesarian section were significantly higher in women presenting in latent phase than those in active phase [13.6%, versus 20.8%, (p=0.001); 38.6% versus 22.4% (p<0.0001) and 34.8% versus 24.0% (p=0.002) respectively. Most of the caesarian section were done due to fetal distress in both groups 24.4% versus 10.0% (p=0.001) respectively. Spontaneous vaginal delivery was higher in active phase than in latent phase 72.0% versus 61.2%, 153/250, (p=0.006), but there were no difference in assisted vaginal delivery between the two groups, In terms of maternal complications, there was more genital tear and postpartum hemorrhage (PPH) in active phase than in latent phase 18.6% versus 15.6% (p=0.013 and 18.4% versus 6.6% (p=0.001) respectively. However, there was no statistical significant difference in fetal outcomes (APGAR score and admission in Neonatal Intensive Care Unit) between newborns delivered by women admitted in latent phase compares to those delivered by women admitted in active phase of labor.

Conclusions: Low risk pregnant women admitted to labor room in latent phase are more subjected to interventions like oxytocin augmentation, artificial rupture of membrane and caesarian section compared to those admitted in active phase of labor. Moreover, fetal distress attributed to caesarian section was also higher in those delivered by women admitted in latent phase of labor. Therefore, pregnant women arriving in latent phase of labor should be admitted in labor room at 4cm cervical dilatation and open the partograph to prevent unnecessary interventions.